1. POPULATION DYNAMICS AND HEALTH Kai-Lit Phua, PhD FLMI Associate Professor School of Medicine & Health Sciences Monash University Malaysia

2. Biographical details Biographical details Kai-Lit Phua received his BA (cum laude) in Public Health & Population Studies from the University of Rochester and his PhD in Sociology (Medical Sociology) from Johns Hopkins University. He also holds professional qualifications from the insurance industry. Prior to joining academia, he worked as a research statistician for the Maryland Department of Health and Mental Hygiene and for the Managed Care Department of a leading insurance company in Singapore. He was awarded an Asian Public Intellectual Senior Fellowship by the Nippon Foundation in 2003. Kai-Lit Phua received his BA (cum laude) in Public Health & Population Studies from the University of Rochester and his PhD in Sociology (Medical Sociology) from Johns Hopkins University. He also holds professional qualifications from the insurance industry. Prior to joining academia, he worked as a research statistician for the Maryland Department of Health and Mental Hygiene and for the Managed Care Department of a leading insurance company in Singapore. He was awarded an Asian Public Intellectual Senior Fellowship by the Nippon Foundation in 2003.

3. DEMOGRAPHY Scientific study of population Scientific study of population Births (Fertility) Births (Fertility) Sickness (Morbidity) Sickness (Morbidity) Deaths (Mortality) Deaths (Mortality) Population movements (Migration) Population movements (Migration) Other e.g. abortion rates, divorce rates etc. Other e.g. abortion rates, divorce rates etc. Scholars often focus on subtopics e.g. teenage fertility, immigrant fertility, Malay fertility, infant mortality, maternal mortality Scholars often focus on subtopics e.g. teenage fertility, immigrant fertility, Malay fertility, infant mortality, maternal mortality

4. DEMOGRAPHY Composition of population --- ethnic, age, sex (also, how many are non-citizens) Composition of population --- ethnic, age, sex (also, how many are non-citizens) Distribution --- % rural, % urban, % suburban. Also, how many citizens live overseas Distribution --- % rural, % urban, % suburban. Also, how many citizens live overseas Growth --- rapid growth, slow growth, population decline Growth --- rapid growth, slow growth, population decline

5. DEMOGRAPHY Population is affected by fertility, mortality and migration rates Final population = Initial population + (Births – Deaths) + (Immigration – Emigration)

6. AGE-SEX COMPOSITION OF A POPULATION Depicted by the Population Pyramid “Young” population: pyramid is triangular “Young” population: pyramid is triangular “Ageing” population: pyramid becomes more and more rectangular “Ageing” population: pyramid becomes more and more rectangular

7. “YOUNG” POPULATION % of total population under age 15 is high Median age as low as 15 or 16 Due to high fertility

8. “AGEING” POPULATION Elderly rises from 5% to more than 20% of total population Elderly rises from 5% to more than 20% of total population Due mainly to low fertility e.g. Japan, Singapore Due mainly to low fertility e.g. Japan, Singapore “Young-old” versus “old-old” “Young-old” versus “old-old” More and more elderly women More and more elderly women More chronic & degenerative diseases More chronic & degenerative diseases Multiple health problems are common in elderly people Multiple health problems are common in elderly people

9. THE DEMOGRAPHIC TRANSITION This refers to the change from: High rates (births and deaths) to Low rates (births and deaths) Death rates drop before birth rates: therefore, there is a period of rapid population growth. This ends when birth rates finally drop. Death rates drop before birth rates: therefore, there is a period of rapid population growth. This ends when birth rates finally drop.

10. DEMOGRAPHIC TRANSITION Falling death rates are due to better nutrition and higher standards of living Falling birth rates are due to social and economic changes: 1) Women stay in school longer 2) More women work outside the home 3) Women marry later 4) Women postpone childbearing 5) People choose to have fewer kids

11. (1) FERTILITY Fertility rates differ by social variables: Differ by religious group e.g. Catholic Church and contraception Differ by social class – lower classes tend to have higher fertility Differ by region – people in rural areas tend to have higher fertility Differ by country – people in poor countries tend to have higher fertility

12. (1) FERTILITY Fertility rates can be affected by: Public policy e.g. some governments pressure couples to have fewer kids, other governments encourage them to have more! Public policy e.g. some governments pressure couples to have fewer kids, other governments encourage them to have more! Culture e.g. religion and contraception Culture e.g. religion and contraception Economics e.g. expense of having kids in industrial versus agricultural societies Economics e.g. expense of having kids in industrial versus agricultural societies Technology e.g. are effective contraceptive methods available? Technology e.g. are effective contraceptive methods available?

13. FERTILITY AND HEALTH High fertility can increase maternal and child mortality High fertility can increase maternal and child mortality Continuous child-bearing can have a negative impact on maternal health Continuous child-bearing can have a negative impact on maternal health Closely-spaced births (<18 months apart) & low birth weight babies (<2,500g) at higher risk Closely-spaced births (<18 months apart) & low birth weight babies (<2,500g) at higher risk Illegal abortions and maternal mortality Illegal abortions and maternal mortality “Female genital mutilation” & maternal mortality “Female genital mutilation” & maternal mortality Sex-selective abortion in China and India Sex-selective abortion in China and India

14. FERTILITY AND HEALTH Problem of teenage pregnancies in USA Problem of teenage pregnancies in USA STDs such as gonorrhea can lead to infertility in women STDs such as gonorrhea can lead to infertility in women Use of condoms reduce transmission of STDS e.g. HIV/AIDS Use of condoms reduce transmission of STDS e.g. HIV/AIDS Monogamous women at risk of being infected with HIV by husbands and boyfriends Monogamous women at risk of being infected with HIV by husbands and boyfriends

15. INFERTILITY AND “ASSISTED REPRODUCTION” Infertility = inability to conceive children Options for infertile couples: Adoption Adoption In some societies: second spouse, or even divorce or even abandonment of “infertile” spouse In some societies: second spouse, or even divorce or even abandonment of “infertile” spouse Treatment for infertility Treatment for infertility Ethical issues e.g. surrogate motherhood, Ethical issues e.g. surrogate motherhood, Baby M case in USA, sperm donors and sperm banks Baby M case in USA, sperm donors and sperm banks

16. (2) MORBIDITY AND MORTALITY The Epidemiological Transition This refers to the change in disease patterns from mostly infectious diseases to mostly chronic and degenerative diseases This refers to the change in disease patterns from mostly infectious diseases to mostly chronic and degenerative diseases Cancer, heart disease, stroke, injuries, diabetes, arthritis etc versus HIV/AIDS, SARS etc Cancer, heart disease, stroke, injuries, diabetes, arthritis etc versus HIV/AIDS, SARS etc

17. MEASURES OF MORTALITY Infant mortality rate (deaths of babies under 1 year old) Infant mortality rate (deaths of babies under 1 year old) Neonatal mortality rate (<28 days after birth) Neonatal mortality rate (<28 days after birth) Postneonatal mortality rate (between 28 days and 1 year old) Postneonatal mortality rate (between 28 days and 1 year old) IMR = Deaths of babies under 1 year X 1,000 Total live births Total live births

18. MEASURES OF MORTALITY IMR = Neonatal Mortality Rate + Postneonatal Mortality Rate IMR = Neonatal Mortality Rate + Postneonatal Mortality Rate Low Birth Weight (<2.5 kg at birth) greatly increases the risk of infant mortality Low Birth Weight (<2.5 kg at birth) greatly increases the risk of infant mortality

19. OTHER MEASURES OF MORTALITY Under 5 mortality rate Under 5 mortality rate Life expectancy at birth Life expectancy at birth Age-specific mortality rates Age-specific mortality rates Cause-specific mortality rates Cause-specific mortality rates Maternal mortality rate Maternal mortality rate

20. MEASURES OF MORBIDITY Very important: Incidence rate Incidence rate Prevalence rate Prevalence rate

21. INCIDENCE RATE No. of NEW cases in fixed time period X 1,000 Population at risk Population at risk

22. PREVALENCE RATE No. of people with a disease X 1,000 Population at risk Population at risk

23. (3) MIGRATION Involuntary: slavery, ethnic persecution, wars, natural disasters, famines Involuntary: slavery, ethnic persecution, wars, natural disasters, famines Voluntary: to seek jobs (skilled or unskilled), to get an education, because of marriage, upon retirement Voluntary: to seek jobs (skilled or unskilled), to get an education, because of marriage, upon retirement------------------------------ Internal migration: within a country e.g. rural to urban Internal migration: within a country e.g. rural to urban International migration: skilled professionals to other countries International migration: skilled professionals to other countries

24. MIGRATION AND HEALTH Migrants (workers, prostitutes, truck drivers) may spread infectious diseases e.g. HIV/AIDS, TB, diphtheria Migrants (workers, prostitutes, truck drivers) may spread infectious diseases e.g. HIV/AIDS, TB, diphtheria Jet travel speeds up disease transmission Jet travel speeds up disease transmission Migrants often live in urban slums and experience adjustment problems (these can affect their physical or mental health) Migrants often live in urban slums and experience adjustment problems (these can affect their physical or mental health)

25. Further reading Adjustment of Hmong (Laotian hill tribe) refugees in America: www.pbs.org/newshour/bb/asia/vietnam/h mong_5-4.html

26. THE END THANK YOU